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deleted264072
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deleted264072
yea get started Benji
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how can doctors be afraid of our profession, when our profession can barely stand united on two feet?
lol, MTM services changing the pharmacy landscape. let's do another nonsense pharmacy study that amounts to nothing and never push for advancing the profession.
BRB, opening another 60+ pharmacy schools😱
lol, MTM services changing the pharmacy landscape. let's do another nonsense pharmacy study that amounts to nothing and never push for advancing the profession.
BRB, opening another 60+ pharmacy schools😱
Your constant negativity is not helpful.
Interesting, but have to admit I am in awe of their lobbying ability to influence another profession. Pharmacy can't even control its own profession with all these new schools opening up...
They better get ready to fight when pharmacogenomics and personalized medicine starts!! They ain't seen nothing yet with MTM
I am doing MTM everyday and I can see there are lot of opportunities for pharmacists to improve patient care and reduce costs for company. Most patients that I do MTM for, have 3 or 4 things in their medication lists that are inappropriate, more expensive that can be replaced with lower cost medications.
Also, oversupply of pharmacists is not always a downside for a profession. It is because there are more available pharmacists to provide care to patients. Furthermore, pharmacists are forced to take on more roles to survive. As a result, it will expand the practice of pharmacy.
One thing I think will help the profession. That is to reduce the cost of education. It is hard but I can imagine people will have less burden on their student loan and have more desire to change the way pharmacy practice.
Also, oversupply of pharmacists is not always a downside for a profession. It is because there are more available pharmacists to provide care to patients. Furthermore, pharmacists are forced to take on more roles to survive. As a result, it will expand the practice of pharmacy.
One thing I think will help the profession. That is to reduce the cost of education. It is hard but I can imagine people will have less burden on their student loan and have more desire to change the way pharmacy practice.
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deleted264072
leave the fancy alone. We know it all means the same thing. What part did you not understand?
drinking that much Kool-Aid is not good for your health
Remind me how much MTM you have done, to be putting down a poster that actually, you know, has done it? Sometimes it is better to just remain silent.
Scared, no. They like every profession are acting in their self interest. Imagine if physicians could dispense RX's... O wait they can. Anyway, they have always been against pharmacist prescribing. I think we realistically could prescribe drugs on a limited formulary quite easily(I mean just look at the VA where pharmacists can prescribe, and patients aren't dying on a large scale level...yet).
Can't we just tell the physicians to stuff it? Does everything new they try to do have to go through pharmacist approval as well?
Ugh, it's all about money. Physicians have the most to lose in ANY change of the healthcare system. I don't blame them for whatever it is their doing.
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I was just thinking the same thing really. Physicians are really getting it from all sides right now. It is hard to stay the top dog forever and without a doubt they are losing that spot more and more. And really, their organization SHOULD do everything it can to look out for their interests. After all, we want the same.
Also, keep in mind that position statements and press releases amount to virtually nothing, it is mostly just posturing anyway (at least, IMO).
just be sure to throw in some tidbit about patient safety and people dying...that'll usually sway people to your argument.
like puppies...we should just start putting pictures of puppies in our press releases and discussion on MTM. Puppies. Think of the puppies.
Thats why...we are easy to pick on and manipulate. Doctors got bitch slapped by the nurses with the NP and now DNP degree. They in turn are going to bitch slap us and make sure we do not get out of line.
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The medical definition of prescribe is to order a medicine or other treatment. I think most people in health care define prescribing as diagnosing and ordering a medication. Prescribing is not diagnosing however you need a diagnosis in order to prescribe.
The system the VA uses is one of the most efficient and cost saving sytems I have ever seen. I have experienced it as employee and as a veteran utilizing services. The VA pharmacists do adjust medications based on a strict protocol with a physician. They are not diagnosing patients. This model works at the VA and could work in the civillian world. It does not chip away at the all mighty power of the doctor.
I think this is partially due to greed and partially a safety concern. How is a pharmacist filling several hundred rxs per day going to have time to order/interpret labs, evaluate a patient, monitor patient, etc? Pharmacists barely have time to do all the crap that they already have to do. Imagine having to get a BP on every patient who walks through your door wanting a new rx for HTN meds. This new class of meds will spell nothing but trouble for pharmacists. Authorizing refills ad infinitum is just going to hurt the patients as well since they do need to be seen to make sure the current therapy is effective. I honestly don't see which healthcare professionals would benefit from this since it will just make everyone's life more difficult.
I'm only picking on this statement because I'm working at one of several hospitals in the area that is understaffed. It's nice to say we'll have a great army of pharmacists to help the patient, but we need to be able to pay them. One thing I really worry about for after graduation: If you take a stand and push for more clinical use of the pharmacists, but it conflicts with the current model (you're not going to be in a chair strictly doing order entry?!), then what stops the DoP from canning you and replacing you with any of the other 20 people that applied for your job?
I don't think posturing from either side is going to benefit either side. Collaboration is the future, and it should be interesting to see how healthcare employment is affected by the AHA being implemented more fully in the coming years. I can only hope to see more floor-based pharmacists rounding with teams and making recommendations/inquiries on the spot rather than chasing them down while staring at a scanned entry a few hours later.
Edit: Forgot this was about OTC-plus. Walgreens, CVS, etc, are going to do everything they can to maximize your productivity and won't give any allowances beyond that.
Thank you. Also, we're experts in medicine, but not in making a diagnosis. I'm not saying pharmacists are incompetent, but we're just not trained enough to do that kind of work.
I really and truly hope a lawsuit in the future will force CVS and Walgreens to provide better staffing at their stores for the sake of the patient.
Exactly. I think this boils down to receiving the level of professional respect that pharmacists deserve but currently don't get. The mainstream sees pharmacists as glorified techs. I feel like these organizations are pushing for these changes since it is seen as gaining more authority. Now your pharmacist can say he can prescribe meds just like doctors and hopefully gain more professional awareness. It takes the pharmacist from the role of order taker to partial order giver and moves you from the low tier of the medical totem pole. Unfortunately, this was of obtaining a new level of autonomy and respect will completely backfire since none of these new responsibilities will be properly reimbursed or staffed.
On a serious note, I don't think most physicians realize what training pharmacists get. I had to have a physical this past week and and she seemed shocked that some people do a b.s. then pharm school. She graduated from some random place called Brown in the 80's and did some thing called a residency at U of R. She also works in this high tech place called a doctors office. Sorry for all the fancy medical jargon I just threw out there, maybe a "doctor" can grace us with their presence and clear those up for us.
Feel better now? It's this kind of attitude that is generating the desire for rx privileges. Unfortunately, most pharm.d's don't have the capability to do so safely. It's the push back to prove how much pharmacists know.
In the immortal words of Johnny Storm...
Flame On!
To the actual meat of the thread:
This works at the VA because it's a closed system. Vets very rarely ever go outside the VISNs to seek care; and when they do, they want to be transferred in. Everything ever done at any VA anywhere gets logged into the same EMR (vista/cprs).
In a closed system, I support this. But, I also work in 2 other EDs where almost every patient can't be bothered to know their diagnoses, much less what they take for them.
"It's in the computer, look it up."
So, if dosages and meds are being changed outside my EMR, I don't know what they're actually taking... and I might prescribe something that interacts and causes an adverse event.
Bad. Aside from harming the patient, it'll be *me* the attorneys go after.
So, while the doctor's office & residency isn't all "high tech," it is a decidedly different practice environment...
To summarize: in a closed system, go for it. I'm all in, and suspect many docs would feel the same. Otherwise, if there are concerns about dosages or less expensive alternatives, let the patient absorb some personal responsibility and bring that up with the person who actually prescribed the meds... sometimes there might be reasons *why* they're on what they are (and, to be fair, sometimes MD/DOs are just dumb).
Cheers!
-d
Sent from my DROID BIONIC using Tapatalk
Flame On!
To the actual meat of the thread:
This works at the VA because it's a closed system. Vets very rarely ever go outside the VISNs to seek care; and when they do, they want to be transferred in. Everything ever done at any VA anywhere gets logged into the same EMR (vista/cprs).
In a closed system, I support this. But, I also work in 2 other EDs where almost every patient can't be bothered to know their diagnoses, much less what they take for them.
"It's in the computer, look it up."
So, if dosages and meds are being changed outside my EMR, I don't know what they're actually taking... and I might prescribe something that interacts and causes an adverse event.
Bad. Aside from harming the patient, it'll be *me* the attorneys go after.
So, while the doctor's office & residency isn't all "high tech," it is a decidedly different practice environment...
To summarize: in a closed system, go for it. I'm all in, and suspect many docs would feel the same. Otherwise, if there are concerns about dosages or less expensive alternatives, let the patient absorb some personal responsibility and bring that up with the person who actually prescribed the meds... sometimes there might be reasons *why* they're on what they are (and, to be fair, sometimes MD/DOs are just dumb).
Cheers!
-d
Sent from my DROID BIONIC using Tapatalk
I guess it's a good thing some people have two professional degrees. Should pharmds have Rx authority just for earning a pharmd? No. Should an md or do be afraid if pharmds have that authority? No. At one point in time an apothecary would ddx and tx pts, but then the chemists needed someone to do their b!tch work, bc when it's all said and done, a pharmacy is where honest sick patients go in hope of receiving mercy.
How's this for a scary question for the mds: If your patients could choose to use their own resources, along with the knowledge and resources of solely a pharmacist versus their own knowledge along with the resources solely a physician, how many patients would you have left?
Hypotheticals shouldn't make you scared...because in reality, not too many people care about the name of their problem if you can't fix it.
How's this for a scary question for the mds: If your patients could choose to use their own resources, along with the knowledge and resources of solely a pharmacist versus their own knowledge along with the resources solely a physician, how many patients would you have left?
Hypotheticals shouldn't make you scared...because in reality, not too many people care about the name of their problem if you can't fix it.
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True. But one can't fix their problem if it's not appropriately diagnosed.
Not all HTN is essential (renal artery stenosis, pheochromocytoma, etc).
Not all HA are primary (neoplasia, pseudotumor, mets, etc).
And on & on & on...
We all have our roles to play, and we're sharing the sandbox. Medicine *is* hypotheticals until a diagnosis is proven... thus the concept of a DDx. d=)
-d
Sent from my DROID BIONIC using Tapatalk
I agree with some of the points mentioned above but VA is not a completely closed system, there is always a leakage. Anyway, a pharmacist is more than capable of monitoring lab work, adding or changing therapy to prediagnosed conditions.
The MD's are not immune to the problems listed above by Daiphon. With great prescribing power will come great liability. I believe that the pharmacist should be held liable if he/she prescribes something stupid, not the MD as per most collaborative practices. This is why I advocate more independent prescribing by the pharmacists.
Let me list a few things that I think a pharmacist should be legally be able to do.
#1- Change capsules to tablets (after checking for proper bioavaility and what not). This is seriously a no brainer.
#2- Change some basic generic drugs within the same class.. Prilosec vs. Nexium etc.
#3- Change dosing of drugs based on various parameters.
The rest I do not care about. I do not see why giving some basic prescribing rights to pharmacists would not result in better patient outcomes. I am not even talking about the ability to add therapy.
The MD's are not immune to the problems listed above by Daiphon. With great prescribing power will come great liability. I believe that the pharmacist should be held liable if he/she prescribes something stupid, not the MD as per most collaborative practices. This is why I advocate more independent prescribing by the pharmacists.
Let me list a few things that I think a pharmacist should be legally be able to do.
#1- Change capsules to tablets (after checking for proper bioavaility and what not). This is seriously a no brainer.
#2- Change some basic generic drugs within the same class.. Prilosec vs. Nexium etc.
#3- Change dosing of drugs based on various parameters.
The rest I do not care about. I do not see why giving some basic prescribing rights to pharmacists would not result in better patient outcomes. I am not even talking about the ability to add therapy.
My preceptor just got a PGY1 physician doing rounds with us. I do pre rounds in the morning and then my preceptor rounds with me in the afternoon to check my work off.
This physician is only with us for 2 weeks. He already told me to take a break and give him all my patients (when originally I was going to give him half of my patients he wants them ALL.)
Okay, that's fine with me LESS WORK for me!
The WORST part of all this is he would call me every 20 minutes and ask me questions about the patient and ask me to teach him and hold his hand on the pre rounds! 🙄
I told him the required readings that must be done and he will always tell me he "forgot" to do them. He will ask me a million questions about the patients and what to do...YET he still thinks he should get ALL the patients and not let me work on any of them. (however, he wants to call me for "help" 100X a day!
)This ladies and gentlemen is a MD's attitude. 🙄
He is also don't listen...I told him to make a copy of the order after he write it and send it to the pharmacy and he says it's no need!
He also FORGOT to label the orders with the patients names!!!! The pharmacy had to call me and ask for the patient's names on each order! WTF....
So this is a MD for you.
First time I ever worked with one and boy its real work.And these guys are suppose to be the smartest of them all? I am not impressed at all after meeting this one...sorry.
So this is a MD for you.
And these guys are suppose to be the smartest of them all? I am not impressed at all after meeting this one...sorry.
Harrowing
My preceptor just got a PGY1 physician doing rounds with us. I do pre rounds in the morning and then my preceptor rounds with me in the afternoon to check my work off.
This physician is only with us for 2 weeks. He already told me to take a break and give him all my patients (when originally I was going to give him half of my patients he wants them ALL.)
Okay, that's fine with me LESS WORK for me!
The WORST part of all this is he would call me every 20 minutes and ask me questions about the patient and ask me to teach him and hold his hand on the pre rounds! 🙄
I told him the required readings that must be done and he will always tell me he "forgot" to do them. He will ask me a million questions about the patients and what to do...YET he still thinks he should get ALL the patients and not let me work on any of them. (however, he wants to call me for "help" 100X a day!
This ladies and gentlemen is a MD's attitude. 🙄
He is also don't listen...I told him to make a copy of the order after he write it and send it to the pharmacy and he says it's no need!
He also FORGOT to label the orders with the patients names!!!! The pharmacy had to call me and ask for the patient's names on each order! WTF....
So this is a MD for you.
And these guys are suppose to be the smartest of them all? I am not impressed at all after meeting this one...sorry.
n=1
My preceptor just got a PGY1 physician doing rounds with us. I do pre rounds in the morning and then my preceptor rounds with me in the afternoon to check my work off.
This physician is only with us for 2 weeks. He already told me to take a break and give him all my patients (when originally I was going to give him half of my patients he wants them ALL.)
Okay, that's fine with me LESS WORK for me!
The WORST part of all this is he would call me every 20 minutes and ask me questions about the patient and ask me to teach him and hold his hand on the pre rounds! 🙄
I told him the required readings that must be done and he will always tell me he "forgot" to do them. He will ask me a million questions about the patients and what to do...YET he still thinks he should get ALL the patients and not let me work on any of them. (however, he wants to call me for "help" 100X a day!
This ladies and gentlemen is a MD's attitude. 🙄
He is also don't listen...I told him to make a copy of the order after he write it and send it to the pharmacy and he says it's no need!
He also FORGOT to label the orders with the patients names!!!! The pharmacy had to call me and ask for the patient's names on each order! WTF....
So this is a MD for you.
And these guys are suppose to be the smartest of them all? I am not impressed at all after meeting this one...sorry.
statistically insignificant.
Doctors are not the smartest of them all, don't ever say that again. They are just the people that wanted to be a doctor. All you have to do is meet minimum requirements to become a doctor.
The smartest of them all do many other things.
You guys haven't hung around the apothecary (aka SDN pharmacy forum) long enough...SHC is our lovable lovebug, we love her no matter what.
I wish we could rename this forum "the apothecary"
I wouldn't have any problem with any of those.
Should be especially obvious now, since a thread about her seems more popular than anything pharmacy related.
Exactly my point. MDs have a job, pharmDs have a job. The difference is when doctors get scared of only semi-realities, it's shameful. On the other hand, The New York Times had a nice equivalent for if/when the tables were turned (see below). Give that a quick look. You think pharmDs are scared if some MDs are robbing people at $3.25 a pop for Zantac, or $3.33 a pop for Soma? Sure you'll get some customers out in the desert if you charge $18 a gallon for gas, but it's because they have no other option or are clueless. Predators.
This is the headline and link:
"Doctors operating their own in-office pharmacies are raising the costs for insurance companies, employers and taxpayers."
http://www.nytimes.com/2012/07/12/business/some-physicians-making-millions-selling-drugs.html
This is the headline and link:
"Doctors operating their own in-office pharmacies are raising the costs for insurance companies, employers and taxpayers."
http://www.nytimes.com/2012/07/12/business/some-physicians-making-millions-selling-drugs.html
Read page 2. It seems like they have to have the medicines specially packaged for in office sale, so the price goes up from the supplier for the specialty packaging.
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You might be in the minority then. I think just having these rights would make pharmacists jobs so much easier. I can't even remember the number of times I have to call the office to change the formulation of a drug and the nurse who has no idea what's going on just gives me the ok
Again, this is statically insignificant. There are some times when an on site pharmacy is justified and needed. I do not think that a lot of doctors do this for profits vs. say convenience for the patients. What really gets on my nerves is when they have agreements with the pharmaceutical companies for zero cost inventories. They are not charged for keeping medications in stock from certain pharmaceutical companies unless it is sold. I find this a moral hazard.
How are they able to do that when pharmacies are not? MAC pricing doesn't apply to them?
They're "special wrapping" might allow for NDC# changes. Who knows, maybe they actually are wrapped with special. Some 14kt gold blister packs or something
Original Manufacturer's AWP (Pfizer) as listed in the 2010 Red Book
$Celebrex 200MG – NDC#00025-1525-31- 100's
AWP - $4.43 per capsule
Repackers AWP's as listed in the 2010 Red Book
$Celebrex 200MG – NDC#66105-0106-10- 100's
AWP - $8.35 per capsule
$Celebrex 200MG – NDC#68387-0552-30- 30's
AWP - $8.60 per capsule
$Celebrex 200MG – NDC#49999-0004-00- 100's
AWP = $9.31 per capsule
Original Manufacturer's AWP (Pfizer) as listed in the 2010 Red Book
$Celebrex 200MG – NDC#00025-1525-31- 100's
AWP - $4.43 per capsule
Repackers AWP's as listed in the 2010 Red Book
$Celebrex 200MG – NDC#66105-0106-10- 100's
AWP - $8.35 per capsule
$Celebrex 200MG – NDC#68387-0552-30- 30's
AWP - $8.60 per capsule
$Celebrex 200MG – NDC#49999-0004-00- 100's
AWP = $9.31 per capsule
It's a loophole in state law that allows huge markups on WC scripts.
